System and method for transfer of primary alarm notification on patient monitoring systems

ABSTRACT

The present application discloses methods and systems for transferring primary alarm notification on patient monitoring systems from a bedside monitor to one or more secondary devices which may operate on a less than fully reliable network. The bedside monitor includes an attached physiological parameter measurement device which detects when a specific physiological parameter measures outside a predetermined range. The bedside monitor then directs the secondary device(s) to annunciate its alarm. Primary alarming responsibility reverts from the secondary device(s) back to the bedside monitor whenever communication between the two is lost or when acknowledgement of the alarm condition by the secondary device is not relayed back to the bedside monitor within a predetermined amount of time.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present specification claims priority from U.S. Provisional PatentApplication No. 61/415,799, entitled “Patient Monitoring System withDual Serial Bus (DSB) Interface” and filed on Nov. 19, 2010, which isherein incorporated by reference in its entirety.

FIELD

This specification relates generally to hospital-based patientmonitoring systems. More particularly, the present specification relatesto a system and method for transferring primary alarm notification fromthe patient bedside monitor to remote secondary devices in acost-effective, fail-safe manner.

BACKGROUND

A patient monitoring system is an electronic medical device thatmeasures a patient's various vital signs, collects and processes allmeasurements as data, and then displays the data graphically and/ornumerically on a viewing screen. Graphical data is displayedcontinuously as data channels on a time axis (waveforms). In addition, agraphical user interface is often included to provide staff with accessto change configuration and alarm limit settings. Patient monitoringsystems are positioned near hospital beds, typically in critical careunits, where they continually monitor patient status via measuringdevices attached to the patient and can be viewed by hospital personnel.The systems are typically on a shelf, attached to the bed, or attachedto a wall. Some patient monitoring systems can only be viewed on a localdisplay, whereas others can be joined to a network and thereby displaydata at other locations, such as central monitoring or clinicians'stations.

Portable patient monitoring systems are available for use by emergencymedical services (EMS) personnel. These systems typically include adefibrillator along with the monitor. Other portable units, such asHolter monitors, are worn by patients for a particular time period andthen returned to the physician for evaluation of the measured andcollected data. Current patient monitoring systems are able to measureand display a variety of vital signs, including, pulse oximetry (SpO₂),electrocardiograph (ECG), invasive blood pressure (IBP), non-invasiveblood pressure (NIBP), electroencephalograph (EEG), body temperature,cardiac output, capnography (CO₂), and respiration. Patient monitoringsystems are capable of measuring and displaying maximum, minimum, andaverage values and frequencies, such as pulse and respiratory rates.

Data collected can be transmitted through fixed wire connections orwireless data communication. Power to patient monitoring systems can besupplied through a main power line or by batteries. While currentpatient monitoring systems are effective in monitoring patientconditions and notifying medical personnel of changes, they are notwithout certain drawbacks and limitations.

Patient monitoring systems are typically equipped with audio and visualalarms to notify medical personnel of changes in the patient's status.The alarm parameters are typically set by medical personnel. Forexample, audible alarms can often be too loud and distracting to otherpatients, personnel and even family members that may be present in thepatient's room. Bright, flashing visual clinician/nurse alarms can alsobe distracting to other patients. Conversely, more subtle visual alarmscan be too difficult to visualize, which can be a result of visualclutter on the monitoring system display or because the visual alarm isnot differentiated enough from other information on the display. Inaddition, it can be difficult for clinicians to silence an active alarm,delaying care to the patient. The typical user interface for alarmcontrol is operated via traditional push-buttons or in many instances atouchscreen or keyboard.

Therefore, a need exists for a better alarm mechanism within patientmonitoring systems, in which both the audible and visual alarms areeasily recognized by the clinicians while not disturbing patients. Inaddition, there is a need for an alarm mechanism in which an attendingclinician can quickly silence the alarm and then focus on the patient'sneeds.

In addition, although visual and audible alarms are generated in analarm situation, there is seldom nursing staff dedicated to watchingthese systems as the nursing staff is busy attending to many patients.System-generated alarms next to the patient will often wake the patient,are often “false” alarms, and are also frightening to the patient'sfamily. It is desirable to have the primary alarming notification occurat the location of the assigned caregiver, not at the patient, since itis the caregiver that needs to take action. One conventional method forproviding alarm notifications at the caregiver location is to repeatinformation from patient monitors located at the patient's bedsidewithin central work stations or send the information to pagers to alertstaff of an alarm situation, specifically for when the staff is notphysically in the patient's room. However, in these redundant systems,the alarm notification is often still present at the bedside and stillhas the drawback of disturbing patients and their families.

Another conventional method involves telemetry transmitters, which haveno primary alarm capabilities and always transfer alarm notifications toa secondary device for primary alarming. Unfortunately, these systemsrequire extensive and expensive equipment to ensure reliable transfer ofprimary alarming function.

Yet another conventional method involves a dedicated networkspecifically for patient monitoring. These networks are designed formaximum redundancy, reliability, and robustness in order to guaranteethe transmission of alarm notifications. Such parallel monitoringnetworks are expensive, however, and not suitable for budget conscioushospitals or in global geographic regions lacking the ability topurchase and support a complex IT infrastructure.

Therefore, a need exists for a cost-effective, fail-safe method ofsending primary alarm notifications from a patient monitor to asecondary device carried by one or more assigned caregivers, instead ofsounding at the patient, and without requiring a discrete and dedicatednetwork infrastructure. In particular, there is a need for acost-effective, fail-safe method of sending primary alarm notificationsfrom a patient monitor to a secondary device carried by one or moreassigned caregivers which runs on a healthcare provider's existingnetwork, even where that existing network is not completely reliable.

SUMMARY

In one embodiment, the present specification is directed towards avolatile or non-volatile computer readable medium, not includingtransmission media for transmitting waves, wherein said mediumcomprises: a first plurality of programmatic instructions, wherein, whenexecuted by a first computing device, said first plurality ofprogrammatic instructions: transmit a message from the first computingdevice to a second computing device wherein said message is a request tohave the first computing device assume primary responsibility forannunciating an alarm; establish and maintain a heartbeat, wherein saidheartbeat provides a consistent confirmation that a communication linkbetween the first computing device and second computing device isoperational; receive data indicative of an alarm state from the secondcomputing device; and in response to receiving said data indicative ofan alarm state from the second computing device, transmit anacknowledgement from the first computing device to the second computingdevice; and a second plurality of programmatic instructions, wherein,when executed by the second computing device, said second plurality ofprogrammatic instructions: receives said message from the firstcomputing device; in response to receiving said message, establish andmaintain said heartbeat; monitor said heartbeat to confirm that acommunication link between the first computing device and secondcomputing device is operational; transmit said data indicative of analarm state; suspend executing programmatic routines for annunciating analarm in response to the alarm state if said acknowledgement from thefirst computing device is received; and cause said alarm to beannunciated in response to the alarm state based on said data indicativeof an alarm state and said heartbeat status.

In one embodiment, the computing device is a bedside monitor.

In one embodiment, the first computing device is at least one of acellular phone, PDA, smart phone, tablet computing device, patientmonitor, custom kiosk, or other computing device capable of executingprogrammatic instructions.

In one embodiment, the second plurality of programmatic instructionscause said alarm to be annunciated at the second computing device inresponse to an alarm state if said heartbeat is not detected. Inaddition, the second plurality of programmatic instructions cause saidalarm to be annunciated at the second computing device in response to analarm state if said heartbeat fails to meet a predefined reliabilitythreshold. Further, the second plurality of programmatic instructionsdoes not cause said alarm to be annunciated at the second computingdevice if the heartbeat is detected and if the acknowledgement isreceived from the first computing device.

In one embodiment, the first plurality of programmatic instructionsgenerates a user prompt to acknowledge receipt of an alarm message atsaid first computing device; receives user input in response to saidprompt to acknowledge receipt of an alarm message; and transmits dataindicative of said user input to the second computing device. Further,the second plurality of programmatic instructions does not cause saidalarm to be annunciated at the second computing device if the heartbeatis detected, if the acknowledgement is received, and if data indicativeof said user input is received. Still further, the second plurality ofprogrammatic instructions does cause said alarm to be annunciated at thesecond computing device if any one of the following occurs: theheartbeat is not detected, the acknowledgement is not received, or dataindicative of said user input is not received.

In one embodiment, the first plurality of programmatic instructionsreceives said data indicative of an alarm state from the secondcomputing device, said first plurality of programmatic instructionscause an alarm to be annunciated at the first computing device.

In another embodiment, the present specification is directed towards avolatile or non-volatile computer readable medium, not includingtransmission media for transmitting waves, wherein said mediumcomprises: a first plurality of programmatic instructions, wherein, whenexecuted by a first computing device, said first plurality ofprogrammatic instructions: receives a message from a bedside monitorwherein said message is a request to have the first computing deviceassume primary responsibility for annunciating an alarm; in response toreceiving said message, establish and maintain a heartbeat, wherein saidheartbeat provides a consistent confirmation that a communication linkbetween the first computing device and the bedside monitor isoperational; receive data indicative of an alarm state from the bedsidemonitor; and in response to receiving said data indicative of an alarmstate from the bedside monitor, transmit an acknowledgement from thefirst computing device to the bedside monitor; and a second plurality ofprogrammatic instructions, wherein, when executed by the bedsidemonitor, said second plurality of programmatic instructions: transmitsaid message from the first computing device; establish and maintainsaid heartbeat; monitor said heartbeat to confirm that a communicationlink between the first computing device and bedside monitor isoperational; transmit said data indicative of an alarm state; suspendexecuting programmatic routines for annunciating an alarm in response tothe alarm state if said acknowledgement from the first computing deviceis received; and cause said alarm to be annunciated in response to thealarm state based on said data indicative of an alarm state andheartbeat status.

In one embodiment, the first computing device is at least one of acellular phone, PDA, smart phone, tablet computing device, patientmonitor, custom kiosk, or other computing device capable of executingprogrammatic instructions.

In one embodiment, the second plurality of programmatic instructionscause said alarm to be annunciated at the bedside monitor in response toan alarm state if said heartbeat is not detected. Further, the secondplurality of programmatic instructions cause said alarm to beannunciated at the bedside monitor in response to an alarm state if theheartbeat fails to meet a predefined reliability threshold. Stillfurther, the second plurality of programmatic instructions does notcause said alarm to be annunciated at the bedside monitor if theheartbeat is detected and if the acknowledgement is received from thefirst computing device.

In one embodiment, the first plurality of programmatic instructionsgenerates a user prompt to acknowledge receipt of an alarm message atsaid first computing device; receives user input in response to saidprompt to acknowledge receipt of an alarm message; and transmits dataindicative of said user input to the bedside monitor. In addition, thesecond plurality of programmatic instructions does not cause said alarmto be annunciated at the bedside monitor if the heartbeat is detected,if the acknowledgement is received, and if data indicative of said userinput is received. Further, the second plurality of programmaticinstructions does cause said alarm to be annunciated at the bedsidemonitor if any one of the following occurs: the heartbeat is notdetected, the acknowledgement is not received, or data indicative ofsaid user input is not received.

In one embodiment, the first plurality of programmatic instructionsreceives said data indicative of an alarm state from the bedsidemonitor, said first plurality of programmatic instructions cause analarm to be annunciated at the first computing device.

The aforementioned and other embodiments of the present specificationshall be described in greater depth in the drawings and detaileddescription provided below.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features and advantages will be further appreciated, asthey become better understood by reference to the detailed descriptionwhen considered in connection with the accompanying drawings:

FIG. 1 is a block diagram illustrating one exemplary embodiment of thealarm priority system, depicting a bedside monitor with physiologicalparameter measurement device and one secondary alarming device;

FIG. 2 is a block diagram illustrating another exemplary embodiment ofthe alarm priority system, depicting a bedside monitor withphysiological parameter measurement device and four secondary alarmingdevices; and,

FIG. 3 is a flow chart describing one exemplary embodiment of the alarmpriority protocol;

FIG. 4 is a flow chart describing another exemplary embodiment of thealarm priority protocol of the present invention including stepsinvolving alarm recognition by a caregiver;

FIG. 5 is a flow chart describing another exemplary embodiment of thealarm priority protocol wherein the bedside monitor requests that asecondary device take primary alarm responsibility; and,

FIG. 6 is a flow chart describing another exemplary embodiment of thealarm priority protocol wherein the bedside monitor requests that asecondary device take primary alarm responsibility, including stepsinvolving alarm recognition by a caregiver.

DETAILED DESCRIPTION

In one embodiment, the present specification discloses systems andmethods for transferring primary alarm notification from the bedsidepatient monitoring system to secondary devices in a cost-effective,fail-safe manner.

In one embodiment, the present invention comprises a first computingdevice, such as a secondary alarming device capable of generating bothaudible and visual alarm notifications during an alarm condition,wherein the first computing device executes a first plurality ofprogrammatic instructions; a second computing device, such as aphysiological parameter measurement device running an embedded algorithmcapable of generating both audible and visual alarm notifications duringan alarm condition (i.e. low heart rate), wherein the second computingdevice executes a second plurality of programmatic instructions; a meansof transferring data between said first and second computing devices;and a protocol designed to determine alarm notification hierarchybetween said first and second computing devices.

In one embodiment, the present invention is comprised of the following:a physiological parameter measurement device running an embeddedalgorithm capable of generating both audible and visual alarmnotifications during an alarm condition (i.e. low heart rate); one ormore secondary alarming devices also capable of generating both audibleand visual alarm notifications during an alarm condition; a means oftransferring data between said physiological parameter measurementdevice and said secondary devices; and, a protocol designed to determinealarm notification hierarchy between said devices.

The at least one first computing device is capable of receiving primaryalarm responsibility from the second computing device. Therefore, thephysiological parameter measurement device of the present invention hasthe capability of transferring primary alarm notification responsibilityto at least one secondary device. The at least one secondary device iscarried by one or more assigned caregivers or positioned at fixedlocations. This serves to lower the incidence of alarm relateddisturbances at the bedside and allows for increased efficiency ofhospital personnel as the audible and visual alarms are only activatedon the secondary devices.

In one embodiment, the system of the present invention is “fail-safe” inthat it assumes that the network between the first computing device andsecond computing device, i.e. the secondary devices and bedside monitor,respectively, may be faulty or intermittent. Thus, while the bedsidemonitor has the ability to transfer primary alarming responsibility toone or more secondary alarming devices on the network, it will alwaysrevert to becoming the primary alarming device if a “heartbeat” and/orspecific acknowledgement criteria are not received from the secondarydevices. Therefore, the bedside monitor remains the primary alarmingdevice if the heartbeat between the bedside monitor and the secondarydevice fails to meet a pre-defined reliability threshold. If there is anintermittent “heartbeat” or an unreliable connection, the system willcease communication with the secondary device. In one embodiment, thesystem determines the number of connection interruptions and assesseswhether the connection environment is reliable enough to allow asecondary device to assume alarm responsibility, based upon apre-defined connection interruption threshold. In one embodiment, thenumber of acceptable connection interruptions or the connectioninterruption threshold is pre-programmed by the user at the bedsidemonitor. In another embodiment, the number of acceptable connectioninterruptions is pre-programmed at the point of manufacture and cannotbe changed.

Upon transfer of primary alarming responsibility to the at least onesecondary device, the bedside monitor, in one embodiment, suspendsexecuting programmatic routines for annunciating an alarm. Thus, in oneembodiment, when an acknowledgement is received, local bedside monitoralarm conditions are suppressed. If, at any point, communication betweendevices fails or an acknowledgement is not received, the alarmroutine(s) residing at the bedside monitor are unsuppressed or activatedand the bedside monitor continues to execute programmatic routines foralarm annunciation.

In another embodiment, the secondary device acts as a redundant alarmingdevice and also alarms when the primary device or bedside monitoralarms. Thus, alarm conditions, in one optional embodiment, are neversuppressed at the bedside monitor. This allows a caregiver to monitorpatients remotely, but also notifies a caregiver that may be present inthe room of an alarm condition. In this case, an alarm may beacknowledged by using any device.

The present specification discloses multiple embodiments. The followingdisclosure is provided in order to enable a person having ordinary skillin the art to practice the invention. Language used in thisspecification should not be interpreted as a general disavowal of anyone specific embodiment or used to limit the claims beyond the meaningof the terms used therein. The general principles defined herein may beapplied to other embodiments and applications without departing from thespirit and scope of the invention. Also, the terminology and phraseologyused is for the purpose of describing exemplary embodiments and shouldnot be considered limiting. Thus, the present invention is to beaccorded the widest scope encompassing numerous alternatives,modifications and equivalents consistent with the principles andfeatures disclosed. For purpose of clarity, details relating totechnical material that is known in the technical fields related to theinvention have not been described in detail so as not to unnecessarilyobscure the present invention.

FIG. 1 is a block diagram illustrating one exemplary embodiment of thealarm priority system 100 of the present invention, depicting a firstcomputing device 120, such as a secondary alarming device, and a secondcomputing device, such as, but not limited to bedside monitor 105further including a physiological parameter measurement device.

In one embodiment, a physiological parameter measurement device 110attached to a bedside monitor 105 executes an embedded algorithm capableof generating both audible and visual alarm notifications during analarm condition. Physiological parameter measurement device 110 andbedside monitor 105 comprise conventional, standard stand-alone ornetworked monitoring systems. The physiological parameter measurementdevice 110 measures a patient parameter and notifies the bedside monitor105 if said parameter falls outside of a normal range, signifying analarm condition.

If primary alarm responsibility has been transferred to a secondarydevice 120, said secondary device 120 will then activate its audible andvisual alarms and the bedside monitor 105 will remain silent.

Secondary alarming device 120 includes at least one of the followingdevices: a cellular phone, PDA, smartphone, tablet, other patientmonitor, custom kiosk and/or any other computing device.

Communication between the bedside monitor 105 and the secondary device120 is maintained via a network connection 115. In one embodiment, datais transferred between the bedside monitor and the secondary device viaa wired network. In another embodiment, data is transferred between thebedside monitor and the secondary device via a wireless network such as802.11a/b/g/n, Bluetooth, or other protocol or standard. In anotherembodiment, data is transferred between the bedside monitor and thesecondary device via a cellular network.

It should further be appreciated that each secondary device andmonitoring system have wireless and wired receivers and transmitterscapable of sending and transmitting data, at least one processor capableof processing programmatic instructions, memory capable of storingprogrammatic instructions, and software comprised of a plurality ofprogrammatic instructions for performing the processes described herein.

In other embodiment, the alarm system can be coupled with more than onesecondary device. FIG. 2 is a block diagram illustrating anotherexemplary embodiment of the alarm priority system 200 of the presentinvention, depicting a second computing device, such as a bedsidemonitor 205 further including a physiological parameter measurementdevice 210 and at least one first computing device, and preferably fourfirst computing devices, such as, but not limited to secondary alarmingdevices 220, 225, 230, 235. Secondary alarming devices 220, 225, 230,235 each include at least one of the following devices: a cellularphone, PDA, smartphone, tablet PC, other patient monitor, custom kioskand/or any other computing device.

In one exemplary embodiment, first secondary device 220 is a cell phone,second secondary device 225 is a tablet PC, third secondary device 230is a computer at a clinician's station, and fourth secondary device 240is a custom display, such as a nurse's station kiosk. In other variousembodiments, any combination of one or more of the secondary deviceslisted above, in addition to any other similar mobile or stationarydevice, can act as a secondary alarming device and assume primary alarmresponsibility from the bedside monitor. These secondary devices arecapable of generating both visual and audible alarms and are eithercarried by assigned caregivers or positioned in locations frequented byhospital personnel during the course of their work.

Communication between the bedside monitor 205 and the secondary devices220, 225, 230, and 235 is maintained via a network connection 215. Inone embodiment, data is transferred between the bedside monitor and thesecondary device via a wired network. In another embodiment, data istransferred between the bedside monitor and the secondary device via awireless network such as 802.11a/b/g/n, Bluetooth, or other wirelesscommunication protocol or standard. In another embodiment, data istransferred between the bedside monitor and the secondary device via acellular network.

FIG. 3 is a flow chart describing one exemplary operational embodimentof the alarm priority process or protocol 300. In one embodiment, thebedside monitor delegates to, and retakes primary alarmingresponsibility from, the at least one secondary device through thefollowing process, as described with respect to FIG. 3. The firstcomputing system, a secondary alarming device, first requests in step305, to become the primary alarming device for the monitoring system.

It should be appreciated that the request may be effectuated by thetransmission of a message from an application executing in the firstcomputing system (in one embodiment, a secondary device) to anapplication executing in the second computing system (in one embodiment,a bedside monitor). Each application is configured to receive, transmit,recognize, interpret, and process such request messages. It shouldfurther be appreciated that both the first and second computing systems,secondary device and monitoring system, respectively, have wireless andwired receivers and transmitters capable of sending and transmittingdata, at least one processor capable of processing programmaticinstructions, memory capable of storing programmatic instructions, andsoftware comprised of a plurality of programmatic instructions forperforming the processes described herein.

The second computing device or bedside monitor either accepts, in step310 a, or denies, in step 310 b, the request from the first computingdevice or secondary alarming device in step 305. If denied, the bedsidemonitor retains, in step 315, primary alarming responsibility and theaction is recorded in the activity log which is created in the system.

Referring back to FIG. 3, if a message formatted and transmitted from asecondary device is received and accepted in step 310 a, bycorresponding software executing in the bedside monitor, a connection isestablished, in step 320, by use of a “heartbeat”, which is a predefinedseries of communications which are designed to confirm that the linkbetween the monitor and secondary device is operational and that thesecondary device is receiving, or capable of receiving, any alarmmessage sent by the bedside monitor. Both the bedside monitor and thesecondary device have installed software that establishes the“heartbeat”, or link, between the two devices. The “heartbeat” may beany series of messages, bits, codes, or other sequential, predefined setof transmitted data. Once established, the connection is maintained bythe “heartbeat”.

If the “heartbeat” connection fails at any time, in step 325, primaryalarming responsibility is returned, in step 315, to the bedside monitoruntil such time as the “heartbeat” is re-established. A failed“heartbeat” generates a technical alarm notification on the secondarydevice and is logged by the system. In one embodiment, if the“heartbeat” fails, then the caregiver must manually re-establish aconnection between the bedside monitor and the secondary device. Inanother embodiment, if the “heartbeat” fails, then a connection betweenthe bedside monitor and secondary device can be establishedautomatically by attempting to connect at predetermined time intervalsuntil the caregiver aborts the connection process manually. In yetanother embodiment, if the “heartbeat” fails, then the connectionbetween the bedside monitor and secondary device can be establishedautomatically by attempting to connect at predetermined time intervalsuntil the maximum number of connection attempts is reached. It should benoted that the predetermined time interval for connection attempts andthe maximum number of connection attempts can be programmed at thebedside monitor, the secondary device, or pre-programmed at point ofmanufacture.

Therefore, the bedside monitor remains the primary alarming device ifthe heartbeat between the bedside monitor and the secondary device failsto meet a pre-defined reliability threshold. If there is an intermittent“heartbeat” or an unreliable connection, the system will ceasecommunication with the secondary device. In one embodiment, the systemdetermines the number of connection interruptions and assesses whetherthe connection environment is reliable enough to allow a secondarydevice to assume alarm responsibility, based upon a pre-definedconnection interruption threshold. In one embodiment, the number ofacceptable connection interruptions or the connection interruptionthreshold is pre-programmed by the user at the bedside monitor. Inanother embodiment, the number of acceptable connection interruptions ispre-programmed at the point of manufacture and cannot be changed.

If the physiological monitoring device detects, in step 335, an alarmcondition while primary alarming responsibility has been transferred tothe at least one secondary device, the bedside monitor subsequentlynotifies, in step 340, the secondary device that an alarm condition ispresent by transmitting an alarm condition message from the bedsidemonitor to the secondary device. The alarm condition message may be anyseries of messages, bits, codes, or other sequential, predefined set oftransmitted data that is recognized by both the bedside monitor andsecondary device. It should further be appreciated that the alarmcondition may contain different types of data, including just anindication that an alarm exists, data indicating the specific nature ofthe condition causing the alarm, and/or data indicating the severity ofthe alarm, among other data.

Once the secondary device receives the alarm message, it annunciates thealarm and sends an acknowledgement, in step 345, to the bedside monitorthat the alarm is being presented on said secondary device. In oneembodiment, the alarm annunciation is an audible alarm, such as a beep,ring, or other sound-based indicator. In one embodiment, the alarmannunciation is a visual alarm, such as a flashing light or status bareither on the secondary device itself or on the display of the secondarydevice, if available. In one embodiment, the alarm annunciation isaudio-visual and can contain a plurality of indicators. In anotherembodiment, the alarm annunciation is customizable. In anotherembodiment, alarm annunciation can be customized in accordance withfeatures available within the secondary device.

If the bedside monitor does not receive said acknowledgement within apredetermined period of time, in step 350, then primary alarmingresponsibility will revert to the bedside monitor, which, as in step315, will assume primary alarm responsibility and is responsible foralarm annunciation. In one embodiment, the predetermined time period isprogrammable. In one embodiment, the predetermined time period isprogrammable at the bedside monitor using an application executing inthe bedside monitor. In another embodiment, the predetermined timeperiod is set at the point of manufacture. In yet another embodiment,the predetermined time period is programmable at the secondary deviceusing an application executing in the secondary device.

Optionally, in one embodiment, the alarm annunciated by the secondarydevice requires acknowledgement by the assigned caregiver. FIG. 4 is aflow chart describing another exemplary embodiment of the alarm priorityprotocol 400 including steps involving alarm recognition by a caregiver.In one optional embodiment, when the alarm is annunciated on thesecondary device, a caregiver must acknowledge the alarm. In oneembodiment, the caregiver acknowledges the alarm by pressing a key onthe secondary device. In another embodiment, when the alarm isannunciated on the secondary device, a caregiver may speak into thedevice and issue a vocal command to acknowledge it. In anotherembodiment, a caregiver may select an acknowledgment button on atouchscreen display that is provided on the secondary device. In otherembodiments, caregiver acknowledgment can take any form that issupported by the secondary device.

In one embodiment, acknowledging the alarm does not silence the alarm.Preferably, it causes a notification to the system, including thebedside monitor, that a caregiver has received and acknowledged thealarm.

In one embodiment, acknowledging the alarm by any method describedabove, or any other contemplated method, silences the alarm.

Referring now to FIG. 4, a secondary device requests, in step 405, tobecome the primary alarming device for the monitoring system. It shouldbe appreciated that the request may be effectuated by the transmissionof a message from an application executing in the first computing system(in one embodiment, a secondary device) to an application executing inthe second computing system (in one embodiment, a bedside monitor). Eachapplication is configured to receive, transmit, recognize, interpret,and process such request messages. It should further be appreciated thatboth the first and second computing systems, secondary device andmonitoring system, respectively, have wireless and wired receivers andtransmitters capable of sending and transmitting data, at least oneprocessor capable of processing programmatic instructions, memorycapable of storing programmatic instructions, and software comprised ofa plurality of programmatic instructions for performing the processesdescribed herein.

The second computing device or bedside monitor either accepts, in step410 a, or denies, in step 410 b, the request from the first computingdevice or secondary alarming device in step 405. If denied, the bedsidemonitor retains, in step 415, primary alarming responsibility and theaction is recorded in the activity log which is created in the system.

Referring back to FIG. 4, if a message formatted and transmitted from asecondary device is received and accepted in step 410 a, bycorresponding software executing in the bedside monitor, a connection isestablished, in step 420, by use of a “heartbeat”, which is a predefinedseries of communications which are designed to confirm that the linkbetween the monitor and secondary device is operational and that thesecondary device is receiving, or capable of receiving, any alarmmessage sent by the bedside monitor. Both the bedside monitor and thesecondary device have installed software that establishes the“heartbeat”, or link, between the two devices. The “heartbeat” may beany series of messages, bits, codes, or other sequential, predefined setof transmitted data. Once established, the connection is maintained bythe “heartbeat”.

If the “heartbeat” connection fails at any time, in step 425, primaryalarming responsibility is returned, in step 415, to the bedside monitoruntil such time as the “heartbeat” is re-established. A failed“heartbeat” generates a technical alarm notification on the secondarydevice and is logged by the system.

In one embodiment, if the “heartbeat” fails, then the caregiver mustmanually re-establish a connection between the bedside monitor and thesecondary device. In another embodiment, if the “heartbeat” fails, thena connection between the bedside monitor and secondary device can beestablished automatically by attempting to connect at predetermined timeintervals until the caregiver aborts the connection process manually. Inyet another embodiment, if the “heartbeat” fails, then the connectionbetween the bedside monitor and secondary device can be establishedautomatically by attempting to connect at predetermined time intervalsuntil the maximum number of connection attempts is reached. It should benoted that the predetermined time interval for connection attempts andthe maximum number of connection attempts can be programmed at thebedside monitor, the secondary device, or pre-programmed at point ofmanufacture.

Therefore, the bedside monitor remains the primary alarming device ifthe heartbeat between the bedside monitor and the secondary device failsto meet a pre-defined reliability threshold. If there is an intermittent“heartbeat” or an unreliable connection, the system will ceasecommunication with the secondary device. In one embodiment, the systemdetermines the number of connection interruptions and assesses whetherthe connection environment is reliable enough to allow a secondarydevice to assume alarm responsibility, based upon a pre-definedconnection interruption threshold. In one embodiment, the number ofacceptable connection interruptions or the connection interruptionthreshold is pre-programmed by the user at the bedside monitor. Inanother embodiment, the number of acceptable connection interruptions ispre-programmed at the point of manufacture and cannot be changed.

If the physiological monitoring device detects, in step 435, an alarmcondition while primary alarming responsibility has been transferred tothe at least one secondary device, the bedside monitor subsequentlynotifies, in step 440, the secondary device that an alarm condition ispresent by transmitting an alarm condition message from the bedsidemonitor to the secondary device. The alarm condition message may be anyseries of messages, bits, codes, or other sequential, predefined set oftransmitted data that is recognized by both the bedside monitor andsecondary device. It should further be appreciated that the alarmcondition may contain different types of data, including just anindication that an alarm exists, data indicating the specific nature ofthe condition causing the alarm, and/or data indicating the severity ofthe alarm, among other data.

If the bedside monitor does not receive said acknowledgement within apredetermined period of time, in step 450, then primary alarmingresponsibility will revert to the bedside monitor, which, as in step415, will assume primary alarm responsibility and is responsible foralarm annunciation. In one embodiment, the predetermined time period isprogrammable. In one embodiment, the predetermined time period isprogrammable at the bedside monitor using an application executing inthe bedside monitor. In another embodiment, the predetermined timeperiod is set at the point of manufacture. In yet another embodiment,the predetermined time period is programmable at the secondary deviceusing an application executing in the secondary device.

Once the secondary device receives the alarm message, it annunciates thealarm and sends an acknowledgement, in step 445, to the bedside monitorthat the alarm is being presented on said secondary device. In oneembodiment, the alarm annunciation is an audible alarm, such as a beep,ring, or other sound-based indicator. In one embodiment, the alarmannunciation is a visual alarm, such as a flashing light or status bareither on the secondary device itself or on the display of the secondarydevice, if available. In one embodiment, the alarm annunciation isaudio-visual and can contain a plurality of indicators. In anotherembodiment, the alarm annunciation is customizable. In anotherembodiment, alarm annunciation can be customized in accordance withfeatures available within the secondary device.

In step 455, when the alarm is annunciated on the secondary device, acaregiver must acknowledge the alarm on the secondary device andsubsequently attends to the patient. If the caregiver does notacknowledge the alarm on the secondary device within a predeterminedamount of time, in step 460, then primary alarming responsibility willrevert to the bedside monitor, which, as in step 415, will assumeprimary alarm responsibility and is responsible for alarm annunciation.As mentioned above, the predetermined time period can be programmable orpre-set at the point of manufacture.

Thus, in one embodiment, a user prompt is generated, via a firstplurality of programmatic instructions at the first computing device(secondary alarming device), so that the user can acknowledge receipt ofan alarm message at the first computing device. The first plurality ofprogrammatic instructions receives user input in response to the promptgenerated to acknowledge receipt of an alarm message and transmits dataindicative of said user input to the bedside monitor.

The alarm content, notification of the alarm by the bedside monitor,annunciation of the alarm by the secondary device, and acknowledgementof the alarm by the caregiver are all logged by the system.

In another embodiment, the bedside monitor can request that a secondarydevice take primary alarm responsibility, rather than the secondarydevice requesting primary alarm responsibility from the bedside monitor.For example, while a nurse is in the patient's room checking on thepatient, the nurse indicates to the patient that the patient needs tosleep. The nurse then presses a “sleep” button on the monitor whichresults in the monitor presenting a list of known secondary devices thatcan take over primary alarm responsibility. At this point, the nurseselects one of the secondary devices and the patient monitor screendims, goes blank, or otherwise darkens so as not to disturb thepatient's sleep. The selected secondary device assumes primary alarmresponsibility and then follows the same protocols as those listedabove. If there are no secondary devices available, the bedside monitorretains primary alarm responsibility.

FIGS. 5 and 6 provide flow charts describing bedside monitor initiatedembodiments of the alarm priority protocol 500, 600 of the presentinvention without and with the steps involving alarm recognition by acaregiver respectively.

FIG. 5 is a flow chart describing one exemplary operational embodimentof the alarm priority process or protocol 500. In one embodiment, thebedside monitor delegates to, and retakes primary alarmingresponsibility from, the at least one secondary device through thefollowing process, as described with respect to FIG. 5. A caregiver, instep 305, pushes a button on the bedside monitor, causing the bedsidemonitor to request that a secondary device assume primary alarmresponsibility for the monitoring system.

It should be appreciated that the request may be effectuated by thetransmission of a message from an application executing in the firstcomputing system (in one embodiment, a secondary device) to anapplication executing in the second computing system (in one embodiment,a bedside monitor). Each application is configured to receive, transmit,recognize, interpret, and process such request messages. It shouldfurther be appreciated that both the first and second computing systems,secondary device and monitoring system, respectively, have wireless andwired receivers and transmitters capable of sending and transmittingdata, at least one processor capable of processing programmaticinstructions, memory capable of storing programmatic instructions, andsoftware comprised of a plurality of programmatic instructions forperforming the processes described herein.

The caregiver selects, in step 510 a, the secondary device to assumeprimary alarm responsibility. The caregiver, in one embodiment, can makethis selection from the bedside monitor itself. In one embodiment, theselection is made from a drop-down menu (or other list type) ofavailable devices. In one embodiment, the caregiver is required to entera password corresponding to the selected device so that the device“pairs” with the bedside monitor. In another embodiment, the caregivermay select a device by “pairing” the device to the bedside monitor,using device pairing techniques that are well-known to those of ordinaryskill in the art.

If no secondary device is available, as in 510 b, the bedside monitorretains, in step 515, primary alarming responsibility and the action isrecorded in the activity log which is created in the system.

Referring back to FIG. 5, if a message formatted and transmitted from asecondary device is received and accepted in step 510 a, bycorresponding software executing in the bedside monitor, a connection isestablished, in step 520, by use of a “heartbeat”, which is a predefinedseries of communications which are designed to confirm that the linkbetween the monitor and secondary device is operational and that thesecondary device is receiving, or capable of receiving, any alarmmessage sent by the bedside monitor. Both the bedside monitor and thesecondary device have installed software that establishes the“heartbeat”, or link, between the two devices. The “heartbeat” may beany series of messages, bits, codes, or other sequential, predefined setof transmitted data. Once established, the connection is maintained bythe “heartbeat”.

If the “heartbeat” connection fails at any time, in step 525, primaryalarming responsibility is returned, in step 515, to the bedside monitoruntil such time as the “heartbeat” is re-established. A failed“heartbeat” generates a technical alarm notification on the secondarydevice and is logged by the system.

In one embodiment, if the “heartbeat” fails, then the caregiver mustmanually re-establish a connection between the bedside monitor and thesecondary device. In another embodiment, if the “heartbeat” fails, thena connection between the bedside monitor and secondary device can beestablished automatically by attempting to connect at predetermined timeintervals until the caregiver aborts the connection process manually. Inyet another embodiment, if the “heartbeat” fails, then the connectionbetween the bedside monitor and secondary device can be establishedautomatically by attempting to connect at predetermined time intervalsuntil the maximum number of connection attempts is reached. It should benoted that the predetermined time interval for connection attempts andthe maximum number of connection attempts can be programmed at thebedside monitor, the secondary device, or pre-programmed at point ofmanufacture.

Therefore, the bedside monitor remains the primary alarming device ifthe heartbeat between the bedside monitor and the secondary device failsto meet a pre-defined reliability threshold. If there is an intermittent“heartbeat” or an unreliable connection, the system will ceasecommunication with the secondary device. In one embodiment, the systemdetermines the number of connection interruptions and assesses whetherthe connection environment is reliable enough to allow a secondarydevice to assume alarm responsibility, based upon a pre-definedconnection interruption threshold. In one embodiment, the number ofacceptable connection interruptions or the connection interruptionthreshold is pre-programmed by the user at the bedside monitor. Inanother embodiment, the number of acceptable connection interruptions ispre-programmed at the point of manufacture and cannot be changed.

If the physiological monitoring device detects, in step 535, an alarmcondition while primary alarming responsibility has been transferred tothe at least one secondary device, the bedside monitor subsequentlynotifies, in step 540, the secondary device that an alarm condition ispresent by transmitting an alarm condition message from the bedsidemonitor to the secondary device. The alarm condition message may be anyseries of messages, bits, codes, or other sequential, predefined set oftransmitted data that is recognized by both the bedside monitor andsecondary device. It should further be appreciated that the alarmcondition may contain different types of data, including just anindication that an alarm exists, data indicating the specific nature ofthe condition causing the alarm, and/or data indicating the severity ofthe alarm, among other data.

Once the secondary device receives the alarm message, it annunciates thealarm and sends an acknowledgement, in step 545, to the bedside monitorthat the alarm is being presented on said secondary device. In oneembodiment, the alarm annunciation is an audible alarm, such as a beep,ring, or other sound-based indicator. In one embodiment, the alarmannunciation is a visual alarm, such as a flashing light or status bareither on the secondary device itself or on the display of the secondarydevice, if available. In one embodiment, the alarm annunciation isaudio-visual and can contain a plurality of indicators. In anotherembodiment, the alarm annunciation is customizable. In anotherembodiment, alarm annunciation can be customized in accordance withfeatures available within the secondary device.

If the bedside monitor does not receive said acknowledgement within apredetermined period of time, in step 550, then primary alarmingresponsibility will revert to the bedside monitor, which, as in step515, will assume primary alarm responsibility and is responsible foralarm annunciation. In one embodiment, the predetermined time period isprogrammable. In one embodiment, the predetermined time period isprogrammable at the bedside monitor using an application executing inthe bedside monitor. In another embodiment, the predetermined timeperiod is set at the point of manufacture. In yet another embodiment,the predetermined time period is programmable at the secondary deviceusing an application executing in the secondary device.

Optionally, in one embodiment, the alarm annunciated by the secondarydevice requires acknowledgement by the assigned caregiver. FIG. 6 is aflow chart describing another exemplary embodiment of the alarm priorityprotocol 600 including steps involving alarm recognition by a caregiver.In one optional embodiment, when the alarm is annunciated on thesecondary device, a caregiver must acknowledge the alarm. In oneembodiment, the caregiver acknowledges the alarm by pressing a key onthe secondary device. In another embodiment, when the alarm isannunciated on the secondary device, a caregiver may speak into thedevice and issue a vocal command to acknowledge it. In anotherembodiment, a caregiver may select an acknowledgment button on atouchscreen display that is provided on the secondary device. In otherembodiments, caregiver acknowledgment can take any form that issupported by the secondary device.

In one embodiment, acknowledging the alarm does not silence the alarm.Preferably, it causes a notification to the system, including thebedside monitor, that a caregiver has received and acknowledged thealarm.

In one embodiment, acknowledging the alarm by any method describedabove, or any other contemplated method, silences the alarm.

In one embodiment, the bedside monitor delegates to, and retakes primaryalarming responsibility from, the at least one secondary device throughthe following process, as described with respect to FIG. 6. A caregiver,in step 605, pushes a button on the bedside monitor, causing the bedsidemonitor to request that a secondary device assume primary alarmresponsibility for the monitoring system.

It should be appreciated that the request may be effectuated by thetransmission of a message from an application executing in the firstcomputing system (in one embodiment, a secondary device) to anapplication executing in the second computing system (in one embodiment,a bedside monitor). Each application is configured to receive, transmit,recognize, interpret, and process such request messages. It shouldfurther be appreciated that both the first and second computing systems,secondary device and monitoring system, respectively, have wireless andwired receivers and transmitters capable of sending and transmittingdata, at least one processor capable of processing programmaticinstructions, memory capable of storing programmatic instructions, andsoftware comprised of a plurality of programmatic instructions forperforming the processes described herein.

The caregiver selects, in step 610 a, the secondary device to assumeprimary alarm responsibility. The caregiver, in one embodiment, can makethis selection from the bedside monitor itself. In one embodiment, theselection is made from a drop-down menu (or other list type) ofavailable devices. In one embodiment, the caregiver is required to entera password corresponding to the selected device so that the device“pairs” with the bedside monitor. In another embodiment, the caregivermay select a device by “pairing” the device to the bedside monitor,using device pairing techniques that are well-known to those of ordinaryskill in the art.

If no secondary device is available, as in 610 b, the bedside monitorretains, in step 615, primary alarming responsibility and the action isrecorded in the activity log which is created in the system.

Referring back to FIG. 6, if a message formatted and transmitted from asecondary device is received and accepted in step 610 a, bycorresponding software executing in the bedside monitor, a connection isestablished, in step 620, by use of a “heartbeat”, which is a predefinedseries of communications which are designed to confirm that the linkbetween the monitor and secondary device is operational and that thesecondary device is receiving, or capable of receiving, any alarmmessage sent by the bedside monitor. Both the bedside monitor and thesecondary device have installed software that establishes the“heartbeat”, or link, between the two devices. The “heartbeat” may beany series of messages, bits, codes, or other sequential, predefined setof transmitted data. Once established, the connection is maintained bythe “heartbeat”.

If the “heartbeat” connection fails at any time, in step 625, primaryalarming responsibility is returned, in step 615, to the bedside monitoruntil such time as the “heartbeat” is re-established. A failed“heartbeat” generates a technical alarm notification on the secondarydevice and is logged by the system.

In one embodiment, if the “heartbeat” fails, then the caregiver mustmanually re-establish a connection between the bedside monitor and thesecondary device. In another embodiment, if the “heartbeat” fails, thena connection between the bedside monitor and secondary device can beestablished automatically by attempting to connect at predetermined timeintervals until the caregiver aborts the connection process manually. Inyet another embodiment, if the “heartbeat” fails, then the connectionbetween the bedside monitor and secondary device can be establishedautomatically by attempting to connect at predetermined time intervalsuntil the maximum number of connection attempts is reached. It should benoted that the predetermined time interval for connection attempts andthe maximum number of connection attempts can be programmed at thebedside monitor, the secondary device, or pre-programmed at point ofmanufacture.

Therefore, the bedside monitor remains the primary alarming device ifthe heartbeat between the bedside monitor and the secondary device failsto meet a pre-defined reliability threshold. If there is an intermittent“heartbeat” or an unreliable connection, the system will ceasecommunication with the secondary device. In one embodiment, the systemdetermines the number of connection interruptions and assesses whetherthe connection environment is reliable enough to allow a secondarydevice to assume alarm responsibility, based upon a pre-definedconnection interruption threshold. In one embodiment, the number ofacceptable connection interruptions or the connection interruptionthreshold is pre-programmed by the user at the bedside monitor. Inanother embodiment, the number of acceptable connection interruptions ispre-programmed at the point of manufacture and cannot be changed.

If the physiological monitoring device detects, in step 635, an alarmcondition while primary alarming responsibility has been transferred tothe at least one secondary device, the bedside monitor subsequentlynotifies, in step 640, the secondary device that an alarm condition ispresent by transmitting an alarm condition message from the bedsidemonitor to the secondary device. The alarm condition message may be anyseries of messages, bits, codes, or other sequential, predefined set oftransmitted data that is recognized by both the bedside monitor andsecondary device. It should further be appreciated that the alarmcondition may contain different types of data, including just anindication that an alarm exists, data indicating the specific nature ofthe condition causing the alarm, and/or data indicating the severity ofthe alarm, among other data.

If the bedside monitor does not receive said acknowledgement within apredetermined period of time, in step 650, then primary alarmingresponsibility will revert to the bedside monitor, which, as in step615, will assume primary alarm responsibility and is responsible foralarm annunciation.

In one embodiment, the predetermined time period is programmable. In oneembodiment, the predetermined time period is programmable at the bedsidemonitor using an application executing in the bedside monitor. Inanother embodiment, the predetermined time period is set at the point ofmanufacture. In yet another embodiment, the predetermined time period isprogrammable at the secondary device using an application executing inthe secondary device.

Once the secondary device receives the alarm message, it annunciates thealarm and sends an acknowledgement, in step 645, to the bedside monitorthat the alarm is being presented on said secondary device. In oneembodiment, the alarm annunciation is an audible alarm, such as a beep,ring, or other sound-based indicator. In one embodiment, the alarmannunciation is a visual alarm, such as a flashing light or status bareither on the secondary device itself or on the display of the secondarydevice, if available. In one embodiment, the alarm annunciation isaudio-visual and can contain a plurality of indicators. In anotherembodiment, the alarm annunciation is customizable. In anotherembodiment, alarm annunciation can be customized in accordance withfeatures available within the secondary device.

In step 655, when the alarm is annunciated on the secondary device, acaregiver must acknowledge the alarm on the secondary device andsubsequently attends to the patient. If the caregiver does notacknowledge the alarm on the secondary device within a predeterminedamount of time, in step 660, then primary alarming responsibility willrevert to the bedside monitor, which, as in step 615, will assumeprimary alarm responsibility and is responsible for alarm annunciation.As mentioned above, the predetermined time period can be programmable orpre-set at the point of manufacture.

Thus, in one embodiment, a user prompt is generated, via a firstplurality of programmatic instructions at the first computing device(secondary alarming device), so that the user can acknowledge receipt ofan alarm message at the first computing device. The first plurality ofprogrammatic instructions receives user input in response to the promptgenerated to acknowledge receipt of an alarm message and transmits dataindicative of said user input to the bedside monitor.

The alarm content, notification of the alarm by the bedside monitor,annunciation of the alarm by the secondary device, and acknowledgementof the alarm by the caregiver are all logged by the system.

As discussed above, in various embodiments, multiple secondary devicesare present on the system. In various embodiments, all of these multipledevices are selected as primary alarming devices. In variousembodiments, with multiple secondary devices assuming primary alarmingresponsibility, multiple various protocols are available to determinealarming hierarchy within the group of secondary devices and between thesecondary devices and the bedside monitor. In one embodiment, when analarm condition arises, all secondary devices alarm and remain alarminguntil each is acknowledged by a caregiver. In another embodiment, whenan alarm condition arises, all secondary devices alarm and remainalarming until one is acknowledged by a caregiver. In anotherembodiment, when an alarm condition arises, the secondary devices alarmsequentially in priority order if an alarm is presented but notacknowledged by a caregiver within a specific period of time. For allembodiments, the alarm content, notification of the alarm by the bedsidemonitor, annunciation of the alarm by the secondary devices, andacknowledgement of the alarm by the caregivers are all logged by thesystem.

In another embodiment, the secondary device acts as a redundant alarmingdevice and also alarms when the primary device (bedside monitor alarms).This allows a caregiver to monitor patients remotely, but also notifiesa caregiver that may be present in the room of an alarm condition. Inthis case, alarm acknowledgement can be effectuated by any device.

It should be clear to one familiar with the prior art, that a multitudeof embodiments exist in which alarm notification hierarchy differs basedon a multitude of possible protocols, and that the embodiments listedabove are meant merely to be exemplary in nature and not all inclusive.

The above examples are merely illustrative of the many applications ofthe system of the present invention. Although only a few embodiments ofthe present invention have been described herein, it should beunderstood that the present invention might be embodied in many otherspecific forms without departing from the spirit or scope of theinvention. Therefore, the present examples and embodiments are to beconsidered as illustrative and not restrictive, and the invention may bemodified within the scope of the appended claims.

1. A volatile or non-volatile computer readable medium, not includingtransmission media for transmitting waves, wherein said mediumcomprises: a. a first plurality of programmatic instructions, wherein,when executed by a first computing device, said first plurality ofprogrammatic instructions: i. transmit a message from the firstcomputing device to a second computing device wherein said message is arequest to have the first computing device assume primary responsibilityfor annunciating an alarm; ii. establish and maintain a heartbeat,wherein said heartbeat provides a consistent confirmation that acommunication link between the first computing device and secondcomputing device is operational; iii. receive data indicative of analarm state from the second computing device; and iv. in response toreceiving said data indicative of an alarm state from the secondcomputing device, transmit an acknowledgement from the first computingdevice to the second computing device; and b. a second plurality ofprogrammatic instructions, wherein, when executed by the secondcomputing device, said second plurality of programmatic instructions: i.receives said message from the first computing device; ii. in responseto receiving said message, establish and maintain said heartbeat; iii.monitor said heartbeat to confirm that a communication link between thefirst computing device and second computing device is operational; iv.transmit said data indicative of an alarm state; v. suspend executingprogrammatic routines for annunciating an alarm in response to the alarmstate if said acknowledgement from the first computing device isreceived; and vi. cause said alarm to be annunciated in response to thealarm state based on said data indicative of an alarm state and saidheartbeat status.
 2. The computer readable medium of claim 1 whereinsaid second computing device is a bedside monitor.
 3. The computerreadable medium of claim 1 wherein said first computing device is atleast one of a cellular phone, PDA, smart phone, tablet computingdevice, patient monitor, custom kiosk, or other computing device capableof executing programmatic instructions.
 4. The computer readable mediumof claim 1, wherein said second plurality of programmatic instructionscause said alarm to be annunciated at the second computing device inresponse to an alarm state if said heartbeat is not detected.
 5. Thecomputer readable medium of claim 1, wherein said second plurality ofprogrammatic instructions cause said alarm to be annunciated at thesecond computing device in response to an alarm state if said heartbeatfails to meet a predefined reliability threshold.
 6. The computerreadable medium of claim 1, wherein said second plurality ofprogrammatic instructions does not cause said alarm to be annunciated atthe second computing device if the heartbeat is detected and if theacknowledgement is received from the first computing device.
 7. Thecomputer readable medium of claim 1, wherein said first plurality ofprogrammatic instructions generates a user prompt to acknowledge receiptof an alarm message at said first computing device.
 8. The computerreadable medium of claim 1, wherein said first plurality of programmaticinstructions receives user input in response to said prompt toacknowledge receipt of an alarm message and transmits data indicative ofsaid user input to the second computing device.
 9. The computer readablemedium of claim 8, wherein said second plurality of programmaticinstructions does not cause said alarm to be annunciated at the secondcomputing device if the heartbeat is detected, if the acknowledgement isreceived, and if data indicative of said user input is received.
 10. Thecomputer readable medium of claim 8, wherein said second plurality ofprogrammatic instructions does cause said alarm to be annunciated at thesecond computing device if any one of the following occurs: theheartbeat is not detected, the acknowledgement is not received, or dataindicative of said user input is not received.
 11. The computer readablemedium of claim 1, wherein when said first plurality of programmaticinstructions receives said data indicative of an alarm state from thesecond computing device, said first plurality of programmaticinstructions cause an alarm to be annunciated at the first computingdevice.
 12. A volatile or non-volatile computer readable medium, notincluding transmission media for transmitting waves, wherein said mediumcomprises: a. a first plurality of programmatic instructions, wherein,when executed by a first computing device, said first plurality ofprogrammatic instructions: i. receives a message from a bedside monitorwherein said message is a request to have the first computing deviceassume primary responsibility for annunciating an alarm; ii. in responseto receiving said message, establish and maintain a heartbeat, whereinsaid heartbeat provides a consistent confirmation that a communicationlink between the first computing device and the bedside monitor isoperational; iii. receive data indicative of an alarm state from thebedside monitor; and iv. in response to receiving said data indicativeof an alarm state from the bedside monitor, transmit an acknowledgementfrom the first computing device to the bedside monitor; and b. a secondplurality of programmatic instructions, wherein, when executed by thebedside monitor, said second plurality of programmatic instructions: i.transmit said message from the first computing device; ii. establish andmaintain said heartbeat; iii. monitor said heartbeat to confirm that acommunication link between the first computing device and bedsidemonitor is operational; iv. transmit said data indicative of an alarmstate; v. suspend executing programmatic routines for annunciating analarm in response to the alarm state if said acknowledgement from thefirst computing device is received; and vi. cause said alarm to beannunciated in response to the alarm state based on said data indicativeof an alarm state and heartbeat status.
 13. The computer readable mediumof claim 12 wherein said first computing device is at least one of acellular phone, PDA, smart phone, tablet computing device, patientmonitor, custom kiosk, or other computing device capable of executingprogrammatic instructions.
 14. The computer readable medium of claim 12,wherein said second plurality of programmatic instructions cause saidalarm to be annunciated at the bedside monitor in response to an alarmstate if said heartbeat is not detected.
 15. The computer readablemedium of claim 12, wherein said second plurality of programmaticinstructions cause said alarm to be annunciated at the bedside monitorin response to an alarm state if the heartbeat fails to meet apredefined reliability threshold.
 16. The computer readable medium ofclaim 12, wherein said second plurality of programmatic instructionsdoes not cause said alarm to be annunciated at the bedside monitor ifthe heartbeat is detected and if the acknowledgement is received fromthe first computing device.
 17. The computer readable medium of claim12, wherein said first plurality of programmatic instructions generatesa user prompt to acknowledge receipt of an alarm message at said firstcomputing device.
 18. The computer readable medium of claim 12, whereinsaid first plurality of programmatic instructions receives user input inresponse to said prompt to acknowledge receipt of an alarm message andtransmits data indicative of said user input to the bedside monitor. 19.The computer readable medium of claim 18, wherein said second pluralityof programmatic instructions does not cause said alarm to be annunciatedat the bedside monitor if the heartbeat is detected, if theacknowledgement is received, and if data indicative of said user inputis received.
 20. The computer readable medium of claim 18, wherein saidsecond plurality of programmatic instructions does cause said alarm tobe annunciated at the bedside monitor if any one of the followingoccurs: the heartbeat is not detected, the acknowledgement is notreceived, or data indicative of said user input is not received.
 21. Thecomputer readable medium of claim 12, wherein when said first pluralityof programmatic instructions receives said data indicative of an alarmstate from the bedside monitor, said first plurality of programmaticinstructions cause an alarm to be annunciated at the first computingdevice.